Reviewer commentary on care judged short of best practice
| Overall care score 3 | Reviewer comments | Comment type (Pos or Neg)/category |
|---|---|---|
| Admission phase score 4 | pH 7.436 | |
| Good history taken of COPD symptoms and normal functional status, | Pos/C | |
| alternative diagnosis of PE and CCF not excluded in a patient with risk factors for both | Neg/B | |
| Clinical cardiovascular exam not thorough (no mention of JVP, pedal oedema, chest expansion, sputum characteristics) | Neg/C | |
| Initial management phase score 4 | Patient received appropriate treatment for COPD (ie, steroids, antibiotics and nebulizers), | Pos/C |
| however the CXR result was never recorded ?looked at | Neg/B | |
| Later management phase score 2 | Although the patient was recorded to be clinically improving 2/7 post admission and team were considering early discharge, his ABG was not improving and patient's SOB+tachypnoea attributed to anxiety, pt (patient) gradually deteriorated | Neg/B |
| Patient changed to inhalers too soon | Neg/C | |
| Seen appropriately by respiratory team, frusemide (furosemide) and aminophylline infusion appropriately suggested | Pos/C | |
| Nursing staff inappropriately withheld oral medications as they thought he was nil by mouth | Neg/C | |
| Developed severe type 2 respiratory failure but no decision on resus status made until patient very unwell. This needed to be made by on call team | Neg/B | |
| Earlier referral to ITU and I.v aminophylline may have changed outcome | Neg/C | |
| Good chest physio(therapy) input | Pos/C | |
| Overall care score 3 | Patient appropriately treated initially with nebs, antibiotics and steroids | Pos/C |
| however patient's treatment plan not escalated until he was in severe type 2 respiratory failure | Neg/B | |
| NIV/ITU not considered in this patient ?why-he had no other co-morbidities and no previous hospital admissions | Neg/C | |
| Resus decision made inappropriately by on call team when patient very unwell | Neg/C |
ABG, arterial blood gases; CCF, congestive cardiac failure; COPD, chronic obstructive pulmonary disease; CXR, chest radiograph; ITU, intensive therapy unit; I.v, intravenous; JVP, jugular venous pressure; nebs, nebuliser; NIV, non-invasive intubation; PE, pulmonary embolus; pt, patient; resus, resuscitation; SOB, shortness of breath.